PR to the rescue - Cerner applications found to improve patient care - Computer Business Review

Cerner applications found to improve patient care - Computer Business Review

Just noticed this little gem. Rattled at all the bad publicity they're getting at the moment re: CPOE and children's hospitals, Cerner's pr agency has swung into action and placed this great little story in the ever business friendly Computer Business Review - yes, that "Business" bit in the title does give it away.

It's called damage limitation. Let's hope the keen PRs get their Christmas bonus. They've earnt it.

Is Cerner Millennium killing the kiddies?

For those, especially in Fujitsu's LSP cluster in Southern England, who are now looking forward to receiving Cerner's Millennium EPR as part of the NPfIT nCRS, here's an interesting blog. It's a comment by a US hospital IT director on the recent article in Pediatrics on CPOE (that's computerised physician order entry): Does Cerner Millennium kill children? I don't think so. (HIStalk)

The Pediatrics paper looked at outcomes at the Children's Hospital of Pittsburgh after the implementation of a Cerner Millennium system. They noticed that deaths in the PICU more than doubled after the Cerner installation.

HISTalk takes a long, cool look at the paper blaming Cerner for the increased death rate.

But one or two salient things emerge that are just a little bit worrying - and could have had a lot to do with the increased paediatric death rate.

Cerner Millennium locks the patient record completely while a pharmacist is processing an order. So if there's a critical episode in PICU, while a pharmacy assistant is footling around processing an order, or just goes out to lunch leaving the record open (couldn't happen, could it?), well, that's just tough. No access. Bye bye baby. Raises the interesting question - if Cerner locks up the patient record, just how old a system is it? We've already had the entertainment of IDX's steam-powered green screen COBOL system imposed on the NHS - only to be unceremoniously booted out of the the Southern cluster because it doesn't work. One consequence of CfH choosing IDX is that the whole of the National Programme will now be running on Tandem mainframes, using the Guardian operating system, from the early 1980s. And HP was thinking of phasing these dinosaurs out after they acquired them in Compaq's goody bag (other sweeties included Digital's exciting Alpha range: good for running VMS - what was HP up to? Trying to set up a computer museum?).

Millennium also worsened medication turnaround times, because it imposes a rigid, highly bureaucratic work process. Anyone familiar with American healthcare IT systems, with their cost counting, budget-conscious and dogmatic work process systems, will recognise this scenario. Partly it's because systems like McKesson's, Cerner's and IDX have been built to help hospitals lodge claims with US health insurance companies, while keeping a tight control on costs. These are businesses, after all. And partly it's thanks to that general American assumption that anyone in front of a computer screen is an uneducated moron who can't be trusted to tie their own shoelaces, never mind make a life or death decision.

Millennium proved even worse than this at Pittsburgh. The order entry system actually stopped nurses from administering meds to patients until a pharmacist had reviewed and approved the medication.

It gets worse and worse. The system was obviously designed by the hospital's finance director. Read the piece, it's unbelievable.

Pittsburgh deserves to join the hallowed ranks of London Ambulance, Charing Cross PACS, etc etc, as great healthcare IT disasters. It reads like a blueprint for just how not to implement an IT system in a hospital.

ECG to EHR/EPR integration

Anyone interested in ECG to ECG and ECG to EHR/EMR/EPR integration might want to look at the next issue of BJHC which will feature an article I've just penned on the subject. That's the February issue.

Covers OpenECG, DICOM Supplement 30, SCP-ECG and moves to XML encoded ECG.

Broad conclusion is that most of the technical work has been done by OpenECG and the SCP-ECG standard, but that lack of uptake and poor metadata and annotation have left it languishing. DICOM 30 attempted to force SCP-ECG into the DICOM template, with less than impressive results.

Basically, the major vendors haven't been too interested in either SCP-ECG or DICOM 30. The first they see as an "academic" European exercise by the usual EU IST suspects (viz universities like Bolognia and Glasgow, and tertiary care university hospitals). Technically good on integration, but with poor toolset support. The latter (that's DICOM 30) they see as unfunctional and limited. Probably because it's a rushed job. Vendors like GE who've invested in DICOM 30 ECG integration report that sales results are "disappointing".

Now they've all had a rocket put up them by the FDA demanding that ECG supporting data for clinical trials must be in XML. Nothing like Big Pharma to get the medical equipment industry's juices going. Look at Personalised Medicine - it's turning into a tracking device for pharma trials. Perhaps that's what Sir Bill Castell intended.

Anyhow, vendors are now looking seriously at packaging ECG waveforms into XML. Philips Medical look like they're taking a big lead here. Of course, XML is a structuring framework. Electrophysiological data looks like it will be packaged into separate files encoded in base64. My guess is that OpenECG's SCP-ECG - which is after all a European standard (or EuroNorm in the parlance), will be used for this bit. XML will bring excellent metadata, annotation and semantic capabilities to the party - which have been lacking in the SCP-ECG and DICOM 30 implementations. XML will make it far easier to integrate ECG into national EHR programme's like the UK's NPfIT, France's DMP and Germany's eGK.

Germany's e-health programme more costly than planned

de.internet.com - Elektronische Gesundheitskarte offenbar deutlich teurer als erwartet

The first phase of Germany's electronic health programme could prove to be three times more expensive than the Federal Government has anticipated, according to the head of the country's association of private health insurers. Klaus Dietz told German news magazine Focus that the Federal Health Ministery's estimate of a 1.5 billion euro price for the eGK (Elektronische GesundheitsKarte) healthcare smartcard was almost certainly wide of the mark. Dietz reckons that the cost of the first phase of the programme is more likely to be around 4 billion euros. Dietz said that insurance premiums would almost certainly have to increase to meet the additional cost of the country's e-health programme.

A spokesman for the TK, the professional health insurance fund, doubted that anyone could predict the cost of eGK until it has been completed. Hermann Baerenfaenger told the magazine that no one knows the cost of the programme.